General Permits (5089)

CERTIFICATION OF E _-;a
FROM REQUIRING A CAMA PERM[ OCT 6j
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resourc astl (er'u' mmission
in an area of environmental concern pursuant to 15 NCAC u c apter 7K: 0203____„
«.�.
Applicant Name —ZA >t /r %tik'� i /! ;. cat J �w�. �, Phone Number
Address /i 5
City ; J 7 1. ,-i �: State zip
Project Location (County, State Road, Water Body, etc.) �E A-Z_)k n�
..�.- ..S / !i /V/ S c' :V
Type and Dimensions of Project P> ; /< ,i ctIJ
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Any person wno proceeas wnn a oeveiopmenl wunaui uie wr+-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a -written statement -has -been -obtained from -adjacent
landowners --certifying --that -they- -tmve--no- -objections-•to--the
proposed- work. ---
This certification of exemption from requiring a CAMA permit is
valid for g0 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
Applicant's signature,
CAMA Official's signature
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203